From health.com
AT A GLANCE
- Psoriasis can affect any part of your skin. Sometimes it can affect multiple parts of your body.
- Your elbows, knees, trunk, and scalp are among the most common areas where psoriasis develops. It can also affect your palms, soles of the feet, nails, face, and genitals.
- Certain areas of the body may be harder to treat with traditional psoriasis creams or gels, and you may need to explore other treatment options.
Psoriasis can affect almost any part of your skin. Sometimes the skin condition can affect multiple areas of the body at once or different areas over time. Could the changes on your skin be a new patch of psoriasis? Here are some places on the body where psoriasis is particularly common. (And keep in mind, the location of your psoriasis could dictate the kind of treatment that’s best for you.)
1. Elbows and Knees
Your elbows and knees are common spots for the most common kind of psoriasis, called plaque psoriasis. It leads to itchy, painful, red patches of skin that are covered by silvery-white scales.
Usually, these patches are found in a symmetrical pattern on the outside of your knee or the outside of the elbow, called the extensor surfaces. These areas may be particularly prone to breakouts because they are exposed to more friction than other parts of your skin.
Treatment: Topical (applied directly to the skin) treatments typically work well. But based on how severe the psoriasis is, you may need different types of medication, such as oral medication, biologics, or light therapy.
2. Trunk, Arms, and Legs
People can commonly have psoriasis in areas that cover a large percentage of their skin, such as the chest, abdomen, back, arms, and legs. Most often, this is the plaque kind of psoriasis. Some people might get a kind of psoriasis called guttate psoriasis in these regions, which causes small red dots.
Treatment: Prescription creams, like vitamin D creams, corticosteroid creams, or coal tar creams, are not as effective when psoriasis affects large portions of the body. Instead, you might need treatment that you take orally or via an injection.
3. Scalp
Around half of people with psoriasis have symptoms affecting their scalp, such as silvery-white scaly patches, itching, and pain. The scalp is one of the first places people typically experience psoriasis symptoms. However, it might not be diagnosed at first, as it’s often first mistaken for severe dandruff (seborrheic dermatitis). It is especially associated with psoriatic arthritis.
Treatment: Some people see improvements with therapeutic creams that are applied directly. However, some people find it difficult to apply the creams to their scalp, and some don’t like the way these creams look cosmetically. So, scalp psoriasis is sometimes undertreated.
4. Face
Although not as common as in other regions, up to half of people with psoriasis may have some psoriasis symptoms on their face at some point. Psoriasis can appear on any part of your face.
Psoriasis on the face may interfere with the typical things you need to do with the muscles of your face, like chew. People with facial psoriasis also tend to have more severe psoriasis symptoms overall.
Treatment: Facial psoriasis may be more difficult to treat than psoriasis in some other parts of the body because the skin there is quite delicate. For example, it’s important not to overuse strong corticosteroid creams on your face.
5. Nails
About 40-50% of people with psoriasis have symptoms that affect their nails. It is especially associated with psoriatic arthritis.
Nail involvement in psoriasis can cause various nail changes, such as:
- Rough nails
- Brittle nails that are prone to crumbling
- Nail pitting (small dents)
- White discoloration
- Red spots on your nails
- Separation of the nail from the underlying nail bed
Treatment: Topical medications are often not very effective at treating nail psoriasis. Injections into the nail or oral therapies may work better.
6. Palms of the Hand and Soles of the Feet
Psoriasis affects the palms of the hands or the soles of the feet in around 15% of people with the skin condition. Another word for this is palmoplantar psoriasis. It can look like plaque psoriasis, but some people get bumpy pustules.
Psoriasis that affects these parts of the body can particularly interfere with your day-to-day activities and quality of life.
Treatment: You can try some of the same topical treatments that are used for psoriasis in other places. However, certain medicated creams might not be as effective where the skin is thick, like calluses on your feet.
7. Skin Folds
Sometimes psoriasis affects areas where your skin folds together, like in your armpit, beneath your breasts, around your anus, around your belly button, or around your ears. It can also affect the external genitalia, especially in males. This type of psoriasis is called inverse psoriasis or intertriginous psoriasis.
Experts used to think that this kind of psoriasis was rare, but it’s now believed to affect about 20-30% of people with psoriasis. Usually, the areas are moist and shiny, not with the whitish scales seen in plaque psoriasis. The areas are usually clearly outlined and symmetric on both sides, with intense itchiness.
Sometimes it’s hard for healthcare providers to distinguish psoriasis in these areas from other kinds of skin conditions that can cause irritation in skin folds.
Psoriasis that affects the genitals is often especially bothersome. It can lead to embarrassment and shame, negatively impacting personal relationships. Instead of smooth and red, psoriasis here is sometimes more like the itchy white flakes of plaque psoriasis.
Treatment: Because the skin folds and sensitive areas have thinner skin, the strongest steroids are not best. Instead, non-steroidal topical medications may be safer for these areas. Your provider may also recommend that you use a powder to keep any lesions in the skin folds dry. If kept moist, you could be at risk for a fungal infection.
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